Nail pigmentation caused by hydroxyurea: Report of 9 cases

Department of Dermatology, Ospedale S. Giovanni de Dio, University of Cagliari, Via Ospedale 54, 09124-Cagliari, Italy.
Journal of the American Academy of Dermatology (Impact Factor: 4.45). 08/2002; 47(1):146-7. DOI: 10.1067/mjd.2002.120910
Source: PubMed


We report a series of 9 patients, 6 men and 3 women, who presented nail hyperpigmentation arising between 6 and 24 months from the start of hydroxyurea therapy. The most commonly observed clinical pattern was that of longitudinal melanonychia. In only 1 patient, who was affected in all 20 nails, we observed longitudinal melanonychia, diffuse melanonychia, and hyperpigmentation of the skin.

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    • "Longitudinal bands are the most common pattern, while transverse melanonychia is probably related to intermittent courses of chemotherapy , due to the direct toxic effect on the nail matrix. These changes have been variably related to genetic predisposition, the toxic effect of hydroxyurea on the nail bed and matrix, photosensitization , and focal stimulation of melanocytes at the matrix level [29] [30]. Cutaneous ulcers during HU therapy, firstly described by Stahl and Silber in 1985 [31], are still today a poorly recognized side effect of this drug, despite them alone accounting for 30% of all dermatologic adverse events reported to the manufacturer worldwide [1]. "
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    ABSTRACT: Hydroxyurea is an antitumoral drug mainly used in the treatment of Philadelphia chromosome-negative myeloproliferative syndromes and sickle-cell disease. Ulcers represent a rare but severe long-term adverse effect of hydroxyurea therapy. Hydroxyurea-induced ulcers are often multiple and bilateral, typically developing in the perimalleolar region, although any cutaneous district is potentially affected. They generally look small, well-defined, shallow with an adherent, yellow, fibrinous necrotic base. A constant finding is also an extremely intense, treatment-resistant pain accompanying these ulcerations. Withdrawal of the drug generally leads to spontaneous healing of these lesions. Care providers tend to show insufficient awareness of this highly debilitating cutaneous side effect, and late or missed diagnoses are frequent. Instead, regular dermatologic screening should be performed on hydroxyurea-treated patients. This article will present a comprehensive review of indexed case reports and clinical studies, followed by a discussion about treatment options aiming at increasing knowledge about this specific topic.

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    ABSTRACT: This article reviews the different nail symptoms produced by drugs. Drug-induced nail abnormalities may result from toxicity to the matrix, the nail bed or the periungual tissues. The most common symptoms include Beau's lines/onychomadesis, melanonychia, onycholysis, and periungual pyogenic granulomas. Nail changes usually affect several nails and in most cases are asymptomatic. Drugs that most frequently produce nail abnormalities include retinoids, indinavir, and cancer chemotherapeutic agents. In this article, we also include nail adverse effects as a result of radiotherapy since they are commonly observed in clinical practice.
    American Journal of Clinical Dermatology 02/2003; 4(1):31-7. DOI:10.2165/00128071-200304010-00004 · 2.73 Impact Factor
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